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AmeriHealth’s services prioritize outcomes over volume

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By Jon Hurdle
Special to Delaware Business Times

Michael Agnew, 30, was struggling to get his GED before he signed up with AmeriHealth Caritas, Delaware’s new Medicaid managed care organization.

Agnew, of Middletown, had been a delivery driver until a serious road accident left him “in a rut” and unsure of what to do next with his life. Then he decided to take advantage of the GED coaching that was available to him as a Medicaid recipient with AmeriHealth.

“They provided the cost of the testing and the preparation,” he said in an interview at a ribbon-cutting for the company’s new Delaware offices at Newark. “I had a contact here at the company that coached me through it, gave me some pointers and made me accountable and it was very easy once they got involved.”

He said he had been unsure of his abilities and that’s why he had remained without a GED for some time. AmeriHealth officers helped him get through the test, and now he feels more confident about his future.

“Now that I have it, I can go out and look for a job that enables me to use my brain rather than my brawn, to make money and support myself and my family,” he said.

GED services are among the benefits that AmeriHealth provides to the approximately 50,000 Medicaid recipients who have signed up since the firm became the newest of Delaware’s two Medicaid managed-care organizations in January. The other, with the remaining 175,000 of the state’s Medicaid recipients, is Highmark Blue Cross Blue Shield Delaware.

Nine months after setting up in Delaware from its base in Philadelphia, AmeriHealth is working hard to get to know its market and to communicate its services, said Market President Emmilyn Lawson.

“We have a very person-centered approach,” she said. “We have a lot of people out in the field, meeting with providers, meeting with members, meeting with community organizations. It’s a very labor-intensive process, but we think it’s important for people to know who we are and for us to get to know who we’re serving.”

With its emphasis on holistic care, such as wellness, behavioral health and even help with transportation to doctor’s visits, the company is joining Delaware’s efforts to incentivize health providers to focus on outcomes rather than the traditional model of measuring patients served.

“We are working very hard in Delaware to get away from where we are paying for individual visits and volume to something where we are paying for population health and outcomes,” said Kara Odom Walker, secretary of the Delaware Department of Health and Social Services. “You will get paid if you are taking care of that population better than you were before, and that is fundamentally a different way of doing health-care business.”

Walker said officials have built in metrics to measure individual health outcomes such as diabetes, blood pressure or pregnancy, as examples of conditions that drive the high cost of health care.

Delaware chose AmeriHealth Caritas, she said, because it understands the need to pursue the outcomes-based model.

“We really wanted a company that was prepared to take care of the population at large, that was willing to talk about value-based payment and to talk about a population that is mostly seeking Medicaid coverage would need,” Walker said in an interview.

Delaware and the federal government spend about $2 billion a year on the state’s approximately 225,000 Medicaid recipients, nearly all of it through the two managed-care organizations, officials said.

That makes Medicaid a significant portion of the state’s overall $4.3 billion budget, and explains the drive to ensure it’s well spent, said Gov. John Carney at the event. “This is really, really important, and our partnership is a really big deal,” he said.

As a small state, Delaware is better suited to controlling costs by providing better quality health care than it would be through expanding an insurance pool, simply because of the small size of its population, Carney said.

“Delaware is the kind of place where you ought to be able to get it done because we’re small and we’re manageable, and that doesn’t work so well when you talk about insurance pools because we have a small pool, that’s the nature of our state,” he said.

The shift to better health outcomes will take time, Walker predicted, but if it works, could establish Delaware as a national leader in figuring out how to care for its low-income population and control costs.

“We know health care is not going to change overnight but we are providing incentives to get insurers and providers aligned so that we can make progress,” she said.

“If we figure that out in Delaware, we will be the first in the country so we are pushing the bar as far
as we can.”

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